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      Isokinetic assessment of the hip muscles in patients with osteoarthritis of the knee

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          Abstract

          OBJECTIVES:

          To evaluate the difference in isokinetic strength of hip muscles between patients with knee osteoarthritis (OA) and matched healthy controls, and to establish the correlation between this isokinetic strength and pain and function in patients with knee OA.

          METHODS:

          25 patients with a diagnosis of unilateral knee OA, 25 patients with bilateral knee OA, and 50 matched controls were evaluated using the visual analog scale for pain, knee Lequesne index, Western Ontario and McMaster Universities questionnaire and an isokinetic test.

          RESULTS:

          The groups were matched for age, gender and body mass index. The results of the isokinetic test revealed lower peak torque of the hip in patients with OA of the knee than in the control group for all movements studied. Strong correlations were found between the peak torque, visual analog scale and function.

          CONCLUSIONS:

          Patients with OA of the knee exhibit lower isokinetic strength in the hip muscles than healthy control subjects. Strengthening the muscles surrounding the hip joint may help to decrease pain in people with knee OA. Some correlations between pain/function and peak torque were found.

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          Most cited references100

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          Repeated chair stands as a measure of lower limb strength in sexagenarian women.

          Despite inadequate empirical validation, sit-to-stand (STS) performance is often used as a proxy measure of lower limb strength among older adults. Furthermore, the relationships between bilateral isokinetic hip, knee, and ankle joint strength and their contributions to STS performances among older adults have not been established. The authors evaluated these relationships on 2 STS tests (5-chair STS test and 30-second chair STS test) in sexagenarian women. 47 women (mean age, 64.50 years) performed both STS tests on the same day and bilateral isokinetic (60 degrees/second) hip extensor, hip flexor, knee extensor, knee flexor, ankle plantar flexor, and ankle dorsiflexor strength testing within 7 days after STS testing. Regression analyses were performed using the average weight-adjusted isokinetic hip, knee, and ankle joint strength scores as the independent variables and both STS test scores as the dependent variables. Regression analyses including all 6 leg strength variables explained 48% (p = .0001) and 35% (p = .007) of the variance in 5-chair STS test scores and 30-second chair STS scores, respectively. Ankle plantar flexor, hip flexor, and knee extensor strength were the strongest predictors for both STS tests. Although ankle plantar flexor, hip flexor, and knee extensor strength play essential roles in performing the STS movement, most STS variance was unexplained, suggesting that important additional variables are also involved in completing the movement.
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            Indexes of severity for osteoarthritis of the hip and knee. Validation--value in comparison with other assessment tests.

            The index for hip disease (ISH) was established, validated and appraised as a new assessment test for the trial of new drugs as well as for long-term follow-up of patients, and to help with future indications for surgery. The ISH deals with pain, maximum walking distance, and some activities of daily living. Inter-observer reproducibility is good (mean deviation 0.55 points; p less than 0.05). In a short-term, double-blind crossover trial, the ISH, judged according to its power to distinguish between the active drug period and the placebo period, appears as one of the best assessment tests. In the long term, total hip prosthesis is most often justified when the ISH score reaches 10-12 points. The index of severity for knee disease (ISK) was validated and appraised by the same statistical methods. Its value in non-steroidal anti-inflammatory drug (NSAID) or analgesic trials is lower than the value of the ISH. However, its use is still justified for that purpose, and for long-term follow-up of osteoarthritis of the knee.
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              Hip abduction moment and protection against medial tibiofemoral osteoarthritis progression.

              To test the hypothesis that a greater peak internal hip abduction moment is associated with a reduced likelihood of ipsilateral medial tibiofemoral osteoarthritis (OA) progression. Fifty-seven persons with knee OA (by definite osteophyte presence and symptoms) were evaluated. Baseline assessments included kinematic and kinetic gait parameters, obtained with an optoelectronic camera system and force platform, with inverse dynamics used to calculate 3-dimensional moments at the joints; pain, using a separate visual analog scale for each knee; and alignment, using full-limb radiographs. Radiographs of the knee in a semiflexed position, with fluoroscopic confirmation of tibial rim alignment, were obtained at baseline and 18 months later. Disease progression was defined as worsening of the grade of medial joint space narrowing. Logistic regression obtained with generalized estimating equations was used to estimate odds ratios (ORs) for progression per unit of hip abduction moment, after excluding knees with the worst joint space grade at baseline (which could not progress). The 57 participants (63% women) with mild to moderate OA had a mean age of 67 years and a mean body mass index of 29. A greater internal hip abduction moment during gait was associated with a reduced likelihood of medial tibiofemoral OA progression, with OR/unit hip abduction moment of 0.52 and a 95% confidence interval (95% CI) of 0.32-0.85. This protective effect persisted after adjustment for age, sex, walking speed, knee pain severity, physical activity, varus malalignment severity, hip OA presence, and hip OA symptom presence, with an adjusted OR of 0.43 a 95% CI of 0.22-0.81. A greater hip abduction moment during gait at baseline protected against ipsilateral medial OA progression from baseline to 18 months. The likelihood of medial tibiofemoral OA progression was reduced 50% per 1 unit of hip abduction moment.
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                Author and article information

                Journal
                Clinics (Sao Paulo)
                Clinics
                Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
                1807-5932
                1980-5322
                December 2010
                : 65
                : 12
                : 1253-1259
                Affiliations
                Universidade Federal de São Paulo ‐ Disciplina de Reumatologia ‐ São Paulo, SP, Brazil.
                Author notes
                E-mail: jnatour@ 123456unifesp.br Tel.: 55 11 5576‐4239
                Article
                cln_65p1253
                10.1590/S1807-59322010001200006
                3020334
                21340212
                3767b8aa-7a7c-4f4b-b83d-a562fcfcf3f6
                Copyright © 2010 Hospital das Clínicas da FMUSP

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 July 2010
                : 4 August 2010
                : 8 September 2010
                Page count
                Pages: 7
                Categories
                Clinical Science

                Medicine
                hip muscles,knee osteoarthritis,isokinetic assessment,peak torque,strength
                Medicine
                hip muscles, knee osteoarthritis, isokinetic assessment, peak torque, strength

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